Remote Complex Care RN: Virtual Care Coordinator

Alignment Healthcare USA, LLC; San Diego (CA); Remote; USD 86,000 - 129,000; Full time

Job summary

Alignment Health is seeking a Complex Care RN to serve as the clinical quarterback for a panel of high-risk Medicare Advantage members, coordinating virtual care to ensure the right care at the right time and improve outcomes.

In our Care Anywhere model, you’ll collaborate with Advanced Practice Clinicians, Care Coordinators, Health Coaches and Social Workers to support chronic disease management, transitions of care, and quality initiatives while adhering to HEDIS guidelines.

Qualifications

• Registered nurse with at least 3 years in complex care or care management.
• Experience with Medicare Advantage, managed care, or value-based care.
• Knowledge of HEDIS, HCC coding, and care gap management.
• Experience in telehealth or virtual care settings.

Responsibilities

• Manage and coordinate care for medically complex Medicare Advantage members.
• Build trusted relationships with members and caregivers via virtual engagement.
• Lead transitions of care after hospital, SNF, or inpatient discharges.
• Complete medication reconciliations and monitor changes in status.
• Identify and escalate clinical concerns to the appropriate provider.
• Partner with multidisciplinary teams to ensure seamless care.
• Support chronic disease management for heart failure, COPD, diabetes, CKD.
• Assist with HEDIS, quality initiatives, and care gap closure.
• Maintain accurate, timely documentation in Athena EMR.

Skills

RN Experience

Telehealth

Care Coordination

Bilingual English/Spanish

HEDIS knowledge

HCC knowledge

Education

ADN

BSN preferred

RN license in CA

CCM certification

Tools

Athena EMR

TalkDesk

Job description

Alignment Health is seeking a Complex Care RN to serve as the clinical quarterback for a panel of high-risk Medicare Advantage members, coordinating virtual care to ensure the right care at the right time and improve outcomes.

In our Care Anywhere model, you’ll collaborate with Advanced Practice Clinicians, Care Coordinators, Health Coaches and Social Workers to support chronic disease management, transitions of care, and quality initiatives while adhering to HEDIS guidelines.